The Theory and Practice of Group Psychotherapy (27 page)

The therapist’s behavior in this example was extremely important for the group. In effect, he said, I value you the members, this group, and this mode of learning. Furthermore, he reinforced norms of self-exploration and honest interaction with the therapist. The transaction was helpful to the therapist (unfortunate are the therapists who cannot learn more about themselves in their therapeutic work) and to Les, who proceeded to explore the payoff in his defiant stance toward the therapist.

Occasionally, less modeling is required of the therapist because of the presence of some ideal group members who fulfill this function. In fact, there have been studies in which selected model-setting members were deliberately introduced into a group.
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In one study, researchers introduced trained confederates (not clients but psychology graduate students) into two outpatient groups.
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The plants pretended to be clients but met regularly in group discussions with the therapists and supervisors. Their role and behavior were planned to facilitate, by their personal example, self-disclosure, free expression of affect, confrontation with the therapists, silencing of monopolists, clique busting, and so on. The two groups were studied (through participant-administered cohesiveness questionnaires and sociometrics) for twenty sessions. The results indicated that the plants, though not the most popular members, were regarded by the other participants as facilitating therapy; moreover, the authors concluded (though there were no control groups) that the plants served to increase group cohesiveness.

Although a trained plant would contribute a form of deceit incompatible with the process of group therapy, the use of such individuals has intriguing clinical implications. For example, a new therapy group could be seeded with an ideal group therapy member from another group, who then continued therapy in two groups. Or an individual who had recently completed group therapy satisfactorily might serve as a model-setting auxiliary therapist during the formative period of a new group. Perhaps an ongoing group might choose to add new members in advance of the graduation of senior members, rather than afterward, to capitalize on the modeling provided by the experienced and successful senior members.

These possibilities aside, it is the therapist who, wittingly or unwittingly, will continue to serve as the chief model-setting figure for the group members. Consequently, it is of the utmost importance that the therapist have sufficient self-confidence to fulfill this function. If therapists feel uncomfortable, they will be more likely to encounter difficulties in this aspect of their role and will often veer to one extreme or the other in their personal engagement in the group: either they will fall back into a comfortable, concealed professional role, or they will escape from the anxiety and responsibility inherent in the leader’s role by abdicating and becoming simply one of the gang.†
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Neophyte therapists are particularly prone to these positions of exaggerated activity or inactivity in the face of the emotional demands of leading therapy groups. Either extreme has unfortunate consequences for the development of group norms. An overly concealed leader will create norms of caution and guardedness. A therapist who retreats from authority will be unable to use the wide range of methods available for the shaping of norms; furthermore, such a therapist creates a group that is unlikely to work fruitfully on important transference issues.

The issue of the transparency of the therapist has implications far beyond the task of norm setting.† When therapists are self-disclosing in the group, not only do they model behavior, but they perform an act that has considerable significance in many other ways for the therapeutic process. Many clients develop conflicted and distorted feelings toward the therapist; the transparency of the therapist facilitates members working through their transference. I shall discuss the ramifications of therapist transparency in great detail in chapter 7. Let us turn now from this general discussion of norms to the specific norms that enhance the power of group therapy.

EXAMPLES OF THERAPEUTIC GROUP NORMS

The Self-Monitoring Group

It is important that the group begin to assume responsibility for its own functioning. If this norm fails to develop, a passive group ensues, whose members are dependent on the leader to supply movement and direction. The leader of such a group, who feels fatigued and irritated by the burden of making everything work, is aware that something has gone awry in the early development of the group. When I lead groups like this, I often experience the members of the group as moviegoers. It’s as though they visit the group each week to see what’s playing; if it happens to interest them, they become engaged in the meeting. If not, “Too bad, Irv! Hope there’ll be a better show next week!” My task in the group then is to help members understand that they
are
the movie. If they do not perform, there is no performance: the screen is blank.

From the very beginning, I attempt to transfer the responsibility of the group to the members. I keep in mind that in the beginning of a group,
I am the only one in the room who has a good definition of what constitutes a good work meeting.
It is my job to teach the members, to share that definition with them. Thus, if the group has a particularly good meeting, I like to label it so. For example, I might comment at the end, “It’s time to stop. It’s too bad, I hate to bring a meeting like this to an end.” In future meetings, I often make a point of referring back to that meeting. In a young group, a particularly hard working meeting is often followed by a meeting in which the members step back a bit from the intensive interaction. In such a meeting, I might comment after a half hour, “I wonder how everyone feels about the meeting today? How would you compare it with last week’s meeting? What did we do differently last week?”

It is also possible to help members develop a definition of a good meeting by asking them to examine and evaluate parts of a single meeting. For example, in the very early meetings of a group, I may interrupt and remark, “I see that an hour has gone by and I’d like to ask, ‘How has the group gone today? Are you satisfied with it? What’s been the most involving part of the meeting so far today? The least involving part?’” The general point is clear: I endeavor to shift the evaluative function from myself to the group members. I say to them, in effect, “You have the ability—and responsibility—to determine when this group is working effectively and when it is wasting its time.”

If a member laments, for example, that “the only involving part of this meeting was the first ten minutes—after that we just chatted for forty-five minutes,” my response is: “Then why did you let it go on? How could you have stopped it?” Or, “All of you seemed to have known this. What prevented you from acting? Why is it always my job to do what you are all able to do?” Soon there will be excellent consensus about what is productive and unproductive group work. (And it will almost invariably be the case that productive work occurs when the group maintains a here-and-now focus—to be discussed in the next chapter.)

Self-Disclosure

Group therapists may disagree about many aspects of the group therapeutic procedure, but there is great consensus about one issue:
self-disclosure is absolutely essential in the group therapeutic process
. Participants will not benefit from group therapy unless they self-disclose and do so fully. I prefer to lead a group with norms that indicate that self-disclosure must occur—but at each member’s own pace. I prefer that members not experience the group as a forced confessional, where deep revelations are wrung from members one by one.
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During pregroup individual meetings, I make these points explicit to clients so that they enter the group fully informed that if they are to benefit from therapy, sooner or later they must share very intimate parts of themselves with the other group members.

Keep in mind that it is the subjective aspect of self-disclosure that is truly important. There may be times when therapists or group observers will mistakenly conclude that the group is not truly disclosing or that the disclosure is superficial or trivial. Often there is an enormous discrepancy between subjective and objective self-disclosure—a discrepancy that, incidentally, confounds research that measures self-disclosure on some standardized scale. Many group therapy members have had few intimate confidantes, and what appears in the group to be minor self-disclosure may be the very first time they have shared this material with anyone. The context of each individual’s disclosure is essential in understanding its significance. Being aware of that context is a crucial part of developing empathy, as the following example illustrates.

• One group member, Mark, spoke slowly and methodically about his intense social anxiety and avoidance. Marie, a young, bitter, and chronically depressed woman bristled at the long and labored elaboration of his difficulties. At one point she wondered aloud why others seemed to be so encouraging of Mark and excited about his speaking, whereas she felt so impatient with the slow pace of the group. She was concerned that she could not get to her personal agenda: to get advice about how to make herself more likable. The feedback she received surprised her: the members felt alienated from her because of her inability to empathize with others. What was happening in the meeting with Mark was a case in point, they told her. They felt that Mark’s self-disclosure in the meeting was a great step forward for him. What interfered with her seeing what others saw? That was the critical question. And exploring that difficulty was the “advice” the group offered.

What about the big secret? A member may come to therapy with an important secret about some central aspect of his or her life—for example, compulsive shoplifting, secret substance abuse, a jail sentence earlier in life, bulimia, transvestism, incest. They feel trapped. Though they wish to work in the therapy group, they are too frightened to share their secret with a large group of people.

In my pregroup individual sessions, I make it clear to such clients that sooner or later they will
have
to share the secret with the other group members. I emphasize that they may do this at their own pace, that they may choose to wait until they feel greater trust in the group, but that, ultimately, the sharing must come if therapy is to proceed. Group members who decide not to share a big secret are destined merely to re-create in the group the same duplicitous modes of relating to others that exist outside the group. To keep the secret hidden, they must guard every possible avenue that might lead to it. Vigilance and guardedness are increased, spontaneity is decreased, and those bearing the secret spin an ever-expanding web of inhibition around themselves.

Sometimes it is adaptive to delay the telling of the secret. Consider the following two group members, John and Charles. John had been a transvestite since the age of twelve and cross-dressed frequently but secretly. Charles entered the group with cancer. He stated that he had done a lot of work learning to cope with his cancer. He knew his prognosis: he would live for two or three more years. He sought group therapy in order to live his remaining life more fully. He especially wanted to relate more intimately with the important people in his life. This seemed like a legitimate goal for group therapy, and I introduced him into a regular outpatient therapy group. (I have fully described this individual’s course of treatment elsewhere.
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)

Both of these clients chose not to disclose their secrets for many sessions. By that time I was getting edgy and impatient. I gave them knowing glances or subtle invitations. Eventually each became fully integrated into the group, developed a deep trust in the other members, and, after about a dozen meetings, chose to reveal himself very fully. In retrospect, their decision to delay was a wise one. The group members had grown to know each of these two members as people, as John and Charles, who were faced with major life problems, not as a transvestite and a cancer patient. John and Charles were justifiably concerned that if they revealed themselves too early, they would be stereotyped and that the stereotype would block other members from knowing them fully.

How can the group leader determine whether the client’s delay in disclosure is appropriate or countertherapeutic? Context matters. Even though there has been no full disclosure, is there, nonetheless, movement, albeit slow, toward increasing openness and trust? Will the passage of time make it easier to disclose, as happened with John and Charles, or will tension and avoidance mount?

Often hanging on to the big secret for too long may be counterproductive. Consider the following example:

• Lisa, a client in a six-month, time-limited group, who had practiced for a few years as a psychologist (after having trained with the group leader!) but fifteen years earlier had given up her practice to enter the business world, where she soon became extraordinarily successful. She entered the group because of dissatisfaction with her social life. Lisa felt lonely and alienated. She knew that she, as she put it, played her cards “too close to the vest”—she was cordial to others and a good listener but tended to remain distant. She attributed this to her enormous wealth, which she felt she must keep concealed so as not to elicit envy and resentment from others.

By the fifth month, Lisa had yet to reveal much of herself. She retained her psychotherapeutic skills and thus proved helpful to many members, who admired her greatly for her unusual perceptiveness and sensitivity. But she had replicated her outside social relationships in the here-and-now of the group, since she felt hidden and distant from the other members. She requested an individual session with the group leader to discuss her participation in the group. During that session the therapist exhorted Lisa to reveal her concerns about her wealth and, especially, her psychotherapy training, warning her that if she waited too much longer, someone would throw a chair at her when she finally told the group she had once been a therapist. Finally, Lisa took the plunge and ultimately, in the very few remaining meetings, did more therapeutic work than in all the earlier meetings combined.